Wechsler on the Case

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Wechsler during his Peace Corps days

Some are called to their professions. Howell Wechsler went into public health for a case of beer.

“I was in the Peace Corps in Zaire [now the Democratic Republic of Congo]. I was teaching English as a foreign language in a small town called Bumba, and there were all these funeral processions with tiny, tiny coffins,” recalls Wechsler, now Director of the Division of Adolescent and School Health (DASH) for the U.S. Centers for Disease Control and Prevention. “I asked a medical professional why so many little kids were dying, and he said it was the measles. He said there were refrigerators filled with vaccine, but people were too afraid to get their kids vaccinated. I said, ‘They love their kids as much as anyone, I can get them to come.’ He said, ‘If you can get 100 kids, I’ll get you a case of beer.’” Wechsler laughs. “My Peace Corps salary allowed for maybe one or two beers a month, so it was very tempting.”

With no media available, Wechsler got his message out through the city’s informal social networks. “The church had a network to see if kids were getting baptized, the government had one for public works.” He put on skits, including one where he boxed the measles, first with his hands tied behind his back, and then (post-vaccination) with both hands free. His efforts were a smash hit.

“Over the course of the entire previous year, they had vaccinated about 400 kids. I worked with nurses, and in just two days we vaccinated more than 2,000 kids. It was social marketing—that’s what we call it now. I was mobilizing the community and developing different ways to communicate the message. They needed to hear about it in a fresh way. After that, I was hooked on public health for life.”

Wechsler came back to the States, earned a master’s degree in public health at Columbia, and got hired to direct the Washington Heights-Inwood Healthy Heart Program in northern Manhattan, reporting to TC professor Chuck Basch. Much of the work, conducted in schools in the two primarily Latino neighborhoods, involved educating teachers, parents and students about the benefits of drinking low-fat milk, exercising, smoking cessation and other ways of reducing risk of heart attack and stroke. Along the way, Basch convinced Wechsler to go for a doctorate in health education at TC.

“It changed everything,” Wechsler says. “I got a firsthand knowledge of how schools work in the real world. Chuck was an important thinker early on in the movement we call coordinated school health, and his evaluation and community organizing classes were invaluable. I still draw on those experiences—in fact, without them, I would never have gotten the position I’m in now or even have worked at CDC. They shaped my vision for what we should do nationally.”

That vision is essentially the DASH mission: to help the nation’s schools realize they can improve health and educational outcomes through high-quality, evidence-based, strategically planned and effectively coordinated school-based programs that target smoking, alcohol and drug abuse, violence, safety, sexual health (prevention of HIV and other sexually transmitted diseases, as well as teen pregnancy), obesity and asthma.

Unfortunately, there are significant bureaucratic obstacles to that objective. One, Wechsler says, is that “Congress tends to appropriate funds for more categorical reasons.” Another is that the education and public health communities don’t communicate terribly well with one another.

“Often they have turf battles,” he says. “Public health people have great frustration with education people. They wonder, ‘Why can’t we just come into the schools and do our programs?’ And they tend to want a harder edge on their evaluation data. Education people often find public health people condescending, pushy and ignorant of how things work in a school setting.”Then, too, the two communities speak different languages —literally. “In public health, ‘surveillance’ means ‘data collection,’” Wechsler says. “In education, it’s something the police do.” Which makes Wechsler—whose mom, a public school teacher, wanted to be a doctor—a uniquely valuable guy.

“Having the two degrees increases my credibility and helps me understand both worlds,” he says. “Ultimately, our goal at DASH is to help them work together.”

It’s an effort, he says, that starts with data systems DASH uses to describe the behaviors and health risks of young people, and what schools are doing about them.

“There are two beautiful things about the data we collect,” he says. “One is that while others collect data on just drugs or just violence, we do it on a cross-section of issues, so we see patterns emerge in adolescent health. The other is that we not only collect national data, but also support state and city agencies to gather the same data at their own levels. That wouldn’t exist without us, and it’s tremendously useful stuff.”

One DASH product is the School Health Index, a self-assessment and planning guide that enables individual schools to grade themselves and develop improvement strategies based on CDC standards for health policies and practices. Two others are the Health Education Curriculum Analysis Tool and the Physical Education Curriculum Analysis Tool, which schools use to improve curricula in those two areas.

“These tools and the data we’ve disseminated have helped schools make dramatic improvements in their health-related policies and programs,” Wechsler says.

Perhaps Wechsler’s biggest frustration is that DASH currently has funds support coordinated school health programs in just 22 states. On the upside, that situation demonstrates the effectiveness of DASH efforts: among states that have done the best job eliminating soft drinks and junk food from their schools, nine of the top 10 are DASH-funded.

Meanwhile, federal agencies are cooperating more, as demonstrated during the recent outbreaks of H1N1 (swine flu), when CDC, the U.S. Department of Education, the U.S. Department of Agriculture and others worked well together.

“Changing human behavior is difficult, and never as simple as it seems,” Wechsler says. But a case of beer can help.